5._Past_Performance_Questionnaire_with_Header 1 .pdf

PAST AND PRESENT PERFORMANCE QUESTIONNAIRE

When Filled In This Document Is Source Selection Sensitive IAW FAR 2.101 and 3.104

A. GENERAL INFORMATION: Please correct any information below known to be inaccurate:

Contractor’s Name:

Telephone Number:

Fax Number:

Point of Contact:

Address:

Project Title or Brief Description of Work:

Contract Number Provided by Offeror: Dollar Amount: $

Contract Period or Dates of Performance Provided by Offeror:

Contractor performed as the Prime Contractor Sub-Contractor Key Personnel.

B. RESPONDENT INFORMATION:

Name of Respondent: Title:

Address: Telephone Number:

Fax Number:

Email Address:

C. FAX COMPLETED SURVEY FORM TO THE GOVERNMENT AT:

D. PERFORMANCE INFORMATION: Choose the number on the scale of 1 to 6 that most accurately describes the contractor’s performance or situation. PLEASE PROVIDE A NARRATIVE

EXPLANATION FOR ANY RATINGS OF 1 OR 2.

1 2 3 4 5 6

NEUTRAL

(N)

UNSATISFACTORY

(U)

MARGINAL

(M)

SATISFACTORY

(S)

VERY

GOOD

(V)

EXCEPTIONAL

(E)

No record of past performance or the record is inconclusive.

Performance did not meet most contractual requirements. There were serious problems and the contractor’s corrective actions were ineffective.

Performance did not meet some contractual requirements.

There were problems, some of a serious nature, for which corrective action was only marginally effective.

Performance met contractual requirements.

There were some minor problems and corrective actions taken by the contractor were satisfactory.

Performance met all contract requirements and exceeded some to the government’s benefit.

There were a few minor problems, which the contractor resolved in a timely, effective manner.

Performance met all contract requirements and exceeded many to the government’s benefit.

Problems, if any, were negligible and were resolved in a timely, highly effective manner.

CONTRACTOR’S NAME: _ CONTRACT NUMBER

Attachment 5 FA3022-14-R-0002 Page 1 of 3

The contractor: N U M S V E

1. Provided experienced managers and supervisors with the technical and administrative abilities needed to meet contract requirements.

1 2 3 4 5 6

2. Demonstrated ability to hire, maintain, and replace, if necessary, qualified personnel during the contract period.

1 2 3 4 5 6

3. Delegated authority to project managers and supervisors commensurate with contract requirements.

1 2 3 4 5 6

4. Home office participated in solving significant local problems. 1 2 3 4 5 6

5. Followed approved quality control plan. 1 2 3 4 5 6

6. Provided effective quality control and/or inspection procedures to meet contract requirements.

1 2 3 4 5 6

7. Corrected deficiencies in timely manner and pursuant to their quality control procedures.

1 2 3 4 5 6

8. Provided timely resolution of contract discrepancies 1 2 3 4 5 6

9. Identified problems as they occurred. 1 2 3 4 5 6

10. Suggested alternative approaches to problems. 1 2 3 4 5 6

11. Displayed initiative to solve problems. 1 2 3 4 5 6

12. Developed realistic progress schedules. 1 2 3 4 5 6

13. Met established project schedules. 1 2 3 4 5 6

14. Provided timely resolution of warranty defects. 1 2 3 4 5 6

15. Was responsive to contract changes. 1 2 3 4 5 6

16. Provided adequate project supervision. 1 2 3 4 5 6

17. Obtained consent of surety for increases in bonding as work-in-progress increased.

1 2 3 4 5 6

18. Paid subcontractors/suppliers in a timely manner. 1 2 3 4 5 6

19. Provided accurate and complete line item cost proposals including all aspects of work required for each task.

1 2 3 4 5 6

20. Cooperated with Government personnel after award. 1 2 3 4 5 6

21. How would you rate the contractor's overall performance? 1 2 3 4 5 6

22.

Was the contractor ever issued a cure or show cause notice under the referenced contract? If yes, explain outcome in “remarks.”

YES/NO

Attachment 5 FA3022-14-R-0002 Page 2 of 3

23. Would you award another contract to this contractor? If not, explain in

“remarks.”

YES/NO

24. Is the contractor rated in CPARS/CCASS? YES/NO

CONTRACTOR’S NAME: _ CONTRACT NUMBER

NOTE: PLEASE PROVIDE REMARKS AS THIS IS SOMETIMES VITAL TO ACCURATE RATING

OF THE CONTRACTOR.

Remarks:

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